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In this study, we aimed to investigate the frequency of postoperative hypothermia in our hospital.In Kecioren Training and Research Hospital, 165 ASA I-III patients between the ages of 18 and 81, whose operation times were longer than 30 minutes were included in this study. In addition to recording the demographic data of the patients, the body temperatures were also measured twice in the preoperative preparation room, and in the postoperative care unit in the forehead with infrared thermometers. The operation types, the durations, the anesthesia types, and the patients heating status in the perioperative period were recorded. If the body temperature was 35oC or below, it was accepted as hypothermia; and if it was 34oC and below, it was accepted as deep hypothermia. We compared the data of normothermic, hypothermic and deep hypothermic patients. 79 women (47.9%) and 86 men (52.1%), totally 165 patients were included in this study. It was detected that 7 patients (4.2%) were heated preoperatively. It was determined that 16 patients (9.7%) were hypothermic in the postoperative period, and 3 of them were deep hypothermic. There were no statistically meaningful differences between the hypothermic and non-hypothermic patients in terms of age, gender, ASA, type of anesthesia, and operation time (p>0.05). Although postoperative hypothermia has not been found as a common problem in our operating theaters, we observed that most of the postoperative hypothermia cases were in percutaneous urological operations. In order to reduce the frequency of postoperative hypothermia, specific precautions for this type of operations should be taken. [Med-Science 2016; 5(1.000): 169-78]

PURPOSE: Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV. METHODS: Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I - Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II - Only propofol and remifentanil was used during maintenance, III - Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV - Only desflurane and remifentanil was used during maintenance. They have been followed up for 24 h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated. RESULTS: VAS scores were significantly lowest in group I (p = 0.001-0.028). PNV incidence was significantly lowest in group I (p = 0.026). PNV incidence was also lower in group III compared to group IV (p = 0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p = 0.005). Heart rates were significantly lower in esmolol groups (group I and III) compared to their controls (p = 0.001) however blood pressures were similar in all groups (p = 0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p = 0.024-0.03). CONCLUSION: Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV.

Purpose: Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV. Methods: Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I – Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II – Only propofol and remifentanil was used during maintenance, III – Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV – Only desflurane and remifentanil was used during maintenance. They have been followed up for 24 h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated. Results: VAS scores were significantly lowest in group I (p = 0.001–0.028). PNV incidence was significantly lowest in group I (p = 0.026). PNV incidence was also lower in group III compared to group IV (p = 0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p = 0.005). Heart rates were significantly lower in esmolol groups (group I and III) compared to their controls (p = 0.001) however blood pressures were similar in all groups (p = 0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p = 0.024–0.03). Conclusion: Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV. Resumo: Objetivo: A dor e a incidência de náusea e vômito no período pós-operatório (NVP) são comuns em pacientes submetidos à colecistectomia laparoscópica. Os agentes simpatolíticos podem diminuir a necessidade de opiáceos ou anestésicos inalatórios ou intravenosos. Neste estudo, nosso objetivo foi analisar os efeitos de esmolol sobre a necessidade de anestésico no período intraoperatório e de analgésico no pós-operatório e a incidência de dor e NVP. Métodos: Sessenta pacientes foram incluídos. Propofol, remifentanil e vecurônio foram usados para a indução. Os grupos de estudo foram os seguintes: grupo I, a infusão de esmolol foi adicionada aos anestésicos (propofol e remifentanil) para manutenção; grupo II, apenas propofol e remifentanil foram usados durante a manutenção; grupo III, a infusão de esmolol foi adicionada aos anestésicos (desflurano e remifentanil) para manutenção; grupo IV, apenas desflurano e remifentanil foram usados durante a manutenção. O período de acompanhamento foi de 24 horas para avaliar a incidência de NVP e a necessidade de analgésicos. Os escores de dor também foram avaliados por meio da Escala Visual Analógica (EVA). Resultados: Os escores EVA foram significativamente menores no grupo I (p = 0,001–0,028). A Incidência de NVP foi significativamente menor no grupo I (p = 0,026). NVP também foi menor no grupo III em relação ao grupo IV (p = 0,032). A necessidade de analgésicos foi significativamente menor no grupo I e menor no grupo III em relação ao grupo IV (p = 0,005). A frequência cardíaca foi significativamente menor nos grupos esmolol (grupos I e III) comparados aos controles (p = 0,001), mas a pressão arterial foi semelhante em todos os grupos (p = 0,594). A comparação entre os grupos esmolol e controles revelou que houve uma diminuição. Conclusão: O uso de esmolol durante a manutenção da anestesia reduz significativamente a necessidade de anestésico-analgésico, dor e incidência de NVP. Keywords: Esmolol, Postoperative pain, Postoperative vomitting, Palavras-chave: Esmolol, Dor no pós-operatório, Vômito no pós-operatório

The mechanism of the antidepressant effect of bupropion is not fully understood. Besides, using it in the treatment of depression, it is found to be effective in reducing withdrawal symptoms due to smoking cessation. A 28-year-old female patient with a history of depression was admitted to emergency department an hour after ingestion of bupropion, quetiapine, and levothyroxine in high doses to commit suicide. While accepting her into the Intensive Care Unit, she was awake, alert, disoriented and agitated. After 2 h, the patient had a generalized tonic–clonic seizure. The necessary treatment was given and 9 h later with hemodynamic improvement, the patients’ mental status improved.Bupropion may cause unusual behaviors such as delusions, paranoia, hallucinations, or confusion. The risk of seizure is strongly dose-dependent. We want to emphasize the importance of early gastric lavage and administration of activated charcoal. Resumo: O mecanismo do efeito antidepressivo de bupropiona ainda não está bem esclarecido. Contudo, seu uso no tratamento de depressão revelou ser eficaz para reduzir os sintomas de abstinência relacionados à cessação do tabagismo. Uma paciente do sexo feminino, 28 anos, com história de depressão, deu entrada no setor de emergência uma hora após a ingestão de bupropiona, quetiapina e levotiroxina em doses elevadas para cometer suicídio. Ao ser internada em unidade de terapia intensiva, estava acordada, alerta, desorientada e agitada. Após duas horas, apresentou uma crise tônico-clônica generalizada. O tratamento necessário foi administrado e nove horas mais tarde, com a estabilização hemodinâmica, o estado mental da paciente melhorou.Bupropiona pode causar comportamentos incomuns, incluindo delírios, paranoia, alucinações ou confusão mental. O risco de convulsão é altamente dependente da dose. Queremos enfatizar a importância da lavagem gástrica precoce e da administração de carvão ativado. Keywords: Bupripion, Intensive care unit, Seizure, Palavras-chave: Bupropiona, Unidade de terapia intensiva, Convulsão

Abstract The mechanism of the antidepressant effect of bupropion is not fully understood. Besides, using it in the treatment of depression, it is found to be effective in reducing withdrawal symptoms due to smoking cessation. A 28-year-old female patient with a history of depression was admitted to emergency department an hour after ingestion of bupropion, quetiapine, and levothyroxine in high doses to commit suicide. While accepting her into the Intensive Care Unit, she was awake, alert, disoriented and agitated. After 2 h, the patient had a generalized tonic-clonic seizure. The necessary treatment was given and 9 h later with hemodynamic improvement, the patients’ mental status improved. Bupropion may cause unusual behaviors such as delusions, paranoia, hallucinations, or confusion. The risk of seizure is strongly dose-dependent. We want to emphasize the importance of early gastric lavage and administration of activated charcoal.

Amaç: Çalışmada esmololün intraoperatif anestezik- postoperatif analjezik gereksinimi, postoperatif kortizol ve prolaktin düzeylerine etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya 60 hasta dahil edilmiştir. Çalışma grupları şu şekilde dizayn edildi; 1: Esmolol infüzyonuna propofol ve remifentanil eklendi, 2: Sadece propofol ve remifentanil, 3: Esmolol infüzyonuna desfluran ve remifentanil eklendi, 4: Sadece desfluran ve remifentanil kullanıldı. Ameliyat öncesi ve sonrası kortizol ve prolaktin seviyeleri ölçüldü.Bulgular: Analjezik gereksinimi tüm gruplar içinde grup 1'de anlamlı olarak düşüktü ve grup 4 ile karşılaştırıldığında grup 3'te düşük bulundu. Kalp hızı esmolol gruplarında (grup 1 ve 3) kontrol gruplarına göre anlamlı olarak daha düşüktü. Prolaktin düzeyleri bütün gruplarda preoperatif değerlere göre postoperatif dönemde anlamlı yüksek bulundu. Ameliyat öncesi seviyelere ile karşılaştırıldığında postoperatif kortizol düzeylerinde grup 1de anlamlı bir azalma gözlendi. Sonuç: Laparoskopik kolesistektomi hastalarında anestezi yönetiminde adjuvan esmolol kullanımı herhangi bir hemodinamik instabiliteye neden olmadan anestezik - analjezik gereksinimini azaltıp postoperatif kortizol yanıtı baskılarken ameliyat sonrası prolaktin yanıtı üzerinde önemli bir etkisi yoktur.

Objective: We aimed to demonstrate to what extent do the right information in patients’ inter-hospital transfers due to the intensive care indications Material and Method: In this study, 38 patients who applied to our general intensive care unit (ICU) from the other hospitals were included. The demographic data of patients, declarations before ICU admission and diagnosis after admission, the reason and accuracy of the transfer, the overall stay time and the treatments in ICU were recorded. Results: Of all the patients, 17 of them (44.7%) were male and 21 of them (55.3%) were female. Of the people who informed the patients 50% were research assistants, 34.2% of them were medical specialists and 15.8% were paramedics. The most common causes of transfer were found to be invasive hemodynamic monitoring (52.6%), mechanical ventilation (36.8%) and the need for dialysis (10.5%). As the patients were evaluated after admission to ICU, the 71.1% of the information about patients was found to be incomplete and/or misleading. The most common health problems that found to be not reported during acceptance were chronic systemic diseases (25.8%), emergent cardiac pathologies (16.1%), malignancy (12.9%), active infection (12.9%), psychiatric disorders (12.9%) and neurological deficiencies (%9,7). Conclusion: This study revealed that the most of the patient transfers were made improperly with incomplete or misleading information and without the tertiary care ICU indication. In order to use ICU effectively, we believe that an efficient system which provides correct information should be used during inter-hospital patient transfer.